State of the School 2012

Challenges, and Plans to Meet Them

That was the key point in, and title of, the 2012 State of the School speech given Wednesday by Dean Richard D. Krugman, MD.

Immediate and huge challenges – in revenue and health care delivery - confront the University of Colorado School of Medicine, Krugman said. Therefore the school can’t dawdle in planning how it will be organized for the years to come.

The medical school has launched a Strategic Planning effort designed to face those challenges, Krugman explained to a crowd of some 200 at the Hensel Phelps West auditorium on the Anschutz Medical Campus.

Krugman, the country’s longest-serving active medical school dean, also discussed treatment of students by faculty and residents, and recounted accomplishments of the school. And at the end, he got a big surprise when he learned that an endowed dean’s chair would be created and named for him.

Regarding strategic planning, the dean reminded the audience of the core question he has posed for two years:

Given our current faculty, facilities, revenues and affiliations, are we organized in a way to assure that we can be as great as we want to be in all our missions – teaching, clinical practice, research and community engagement?

“My hunch,” he said Wednesday, “is that we are not.”

The answers to his question are still to come in this effort, which has involved a wide cross-section of the school and has been structured with task forces for each of the school’s four missions. But Krugman cited several emerging ideas.

An example from the Community Engagement group: “Integrate community initiatives into all other SOM missions.”

The Education task force is working on strategies to “align educational programs in the SOM and University at large” and with evolving clinical priorities such as quality improvement.

Research is focusing on issues such as improving the speed and quality with which grants and contracts are administered and evaluated. Krugman said that discussions also have focused on team science and innovation. Should there be, for example, a Cancer Biology Department? And given financial limitations, should the school support “the best science, not all science.”

One of the emerging themes of clinical care was to foster “integration of clinical care across departments and with our hospital partners.”

Krugman, while reminding the audience that he was not steering the process toward any pre-determined goals, which he does not have, did suggest a few more notions. For example, he asked, “Can we have a clinical incentive plan that rewards quality, safety and academic success in addition to patient revenue?”

A timeline the dean presented shows that the plans should be developed by June.

The dean recounted some statistics about the medical school that are telling in an era of flat or reduced state support:

Of the $429 million in grants and contracts that flowed to the University of Colorado Denver, $332.8 million were from the medical school.

Clinical revenue has experienced an average 11 percent revenue growth in recent years, which declined a bit last year. Four percent is from volume.

The Academic Enrichment Fund has contributed more than $285 million to school expenditures since 1982 through June 2012.

The CU Foundation has raised more than $30 million for the school this year to date.

Diversity of the first-year classes has about quadrupled in the last few years, in part with help from the president’s office.

Krugman also tackled the issue of what he termed the national problem of “medical student abuse” by faculty or residents. He recounted how a CU student told him just that day of being “humiliated” by a faculty member at an affiliate hospital with others present.

Only a very small percentage of those who teach the medical students treat them poorly, Krugman said, but the students never forget that abuse. It can overshadow a lot of the positive treatment in retrospect.

“What are we going to do about it?” Krugman asked.

His answer in part was to propose going beyond the school’s professionalism reporting system to urge staff and nurses to actively address bad behavior when they see it. Krugman said the school cannot tolerate what he called “gaze aversion, turning away from abuse,” a term he has used to describe what happens with child abuse.

Soon after, the dean was done. Or so he thought.

E. Chester Ridgway, MD, the senior associate dean for academic affairs, and Lilly Marks, vice president for Health Affairs at the University of Colorado and executive vice chancellor of the Anschutz Medical Campus, combined forces to tell the dean about the creation of an endowed dean’s chair – which will carry the name of Richard D. Krugman.

Financial support for the Krugman chair has come from the clinical chairs, University of Colorado Health, Children’s Hospital Colorado and UPI.

Surprised, the dean was nearly speechless. He did, however, manage to ask with a smile, “You don’t need a check?”